More hospitals have ended up in the red.
Photograph: Justin Kaseztwoz/Alamy

The NHS is highly unlikely to make the £22bn of efficiency savings it has agreed and so is likely to need the next government to give it even more than the £8bn extra a year it has already asked for from the Treasury, the King’s Fund warned on Thursday. The thinktank’s gloomy prognosis is based on a survey of the views of finance directors of hospital trusts and other NHS organisations, amajority of whom voiced deep pessimism about the target.

Last October Simon Stevens, the chief executive of NHS England, committed the service to plugging £22bn of the expected £30bn gap in its finances by 2020 through productivity gains of 2% or 3% a year between now and 2020. Since then the Conservatives and Liberal Democrats have promised to provide the other £8bn by 2020 from government funds, though Labour has refused to do the same.

“It’s quite possible that the NHS will miss the £22bn target by quite a long way and therefore require much more than £8bn in additional funding. That’s a realistic possibility”, said Richard Murray, the King’s Fund’s director of policy.

The £22bn target was “looking increasingly unlikely” because more hospitals had ended up in the red since Stevens first outlined the deal in the NHS Five Year Forward View, his blueprint for ensuring the service’s future, Murray said. “It’s not impossible that it will be met. But at the moment it’s more likely that the NHS will miss it than hit it,” he said.

Sixty-nine of the 93 finance heads at NHS trusts questioned said there was either a high or very high risk of the NHS in England failing to achieve the £22bn. Only six thought there was very little or little risk of failure, while 18 put it at 50/50.

Among 40 finance directors at GP-led NHS clinical commissioning groups, which between them spend £69.2bn a year on patient care, 27 said there was either a high or very high risk of the NHS not making the productivity gains Stevens wants to see. Thirteen others put the risk at 50/50, while none identified little or very little chance of failure.

Norman Lamb, the Liberal Democrat health minister, has previously described the £22bn as “an heroic assumption”. Sources close to Lamb said he still sees it as “stretching”. Doubts about the realism of the £22bn target are partly why Lamb is urging the other parties to back the Lib Dems’ call for a non-partisan fundamental review after the election of what money will be needed in the next few years to create a high-quality healthcare system.

A Conservative spokesman said: “We have committed to at least an additional £8bn a year by 2020, which is the money the NHS said it needed to deliver £22bn efficiency savings.”

Paul Briddock, director of policy at the Healthcare Financial Management Association, which represents 5,000 finance staff in the NHS, said: “Both the Tories and the Lib Dems have pledged an extra £8bn, but even with this, achieving £22bn in efficiency savings is unprecedented. It’s going to be a huge challenge for the NHS and will mean providing a level of savings that have never been achieved in the past.”